It occurs to me that I ought to thank Mark Hyman, “pioneer of functional medicine,” and creator of “Ultrawellness,” particularly since he started blogging for that wretched hive of scum and quackery (WHSQ), The Huffington Post. He may not post all that often, but when he does I can be assured that the woo will be flowing in torrents from HuffPo to my computer screen, thus providing me with yet another dose of blogging material. Not surprisingly, given Hyman’s history, his latest bit on HuffPo is no different. Entitled Cancer Research: New Science on How to Prevent and Treat Cancer From TEDMED 2010, it’s a veritable orgy of miscomprehension of the latest cancer research. Whether willful or not, I don’t know, but I do know it’s embarrassing to read, knowing that a fellow physician can take legitimate scientific research, as Dr. Hyman does, and turn it to the service of pure woo.

It starts out unpromisingly right from the beginning:

Conventional medicine has lost its battle with cancer. But that doesn’t mean the war is over. Let me explain why we may finally be heading in the right direction.

Ah, yes. Whenever you see someone like Dr. Hyman declare the “war on cancer” to have been definitively lost, I know I’m about to be treated (if you can call it that) to a heapin’ helpin’ of the most annoying woo. Dr. Hyman doesn’t disappoint. Apparently he somhow scored and invitation to speak at the latest TEDMED, along with the usual eclectic mix of speakers, which included Dr. Mehment Oz (big surprise) and, shockingly, someone I once worked with. Sadly, Deepak Chopra was also there bloviating about whether you can change your genes. Overall, it looked as though, had I attended, I would have alternated between being enthralled and appalled by what I heard, which, as far as I can tell, seems to be the M.O. of TED talks. Certainly, from what I’ve seen the “cutting edge” or “innovative” stuff often passes beyond the line dividing the frontiers of science and pure woo. Guess on which side of the line Dr. Hyman falls?

He’s clever, though. I’ll give Dr. Hyman at least that much. He knows when something is going on in medicine that he can co-opt as being supportive of his woo, and this post is no different:

Instead of dividing everything into diseases and labels, emerging science is pointing to a different way of thinking about diseases. The thread that ran through the conference was that disease is a systemic problem and we have to treat the system, not the symptom; the cause, not the disease. This completely redefines the whole notion of disease. The landscape of illness is changing.

At TEDMED I spoke about a new way to define disease, to navigate the landscape of illness. It is called functional medicine, which is a systems-biology approach to personalized medicine that focuses on the underlying causes of disease. That definition of functional medicine is a mouthful. But in a word, it is the medicine of WHY, not WHAT.

It’s true that systems biology is one of the hottest areas in medicine right now. It’s also true that systems biology emphasizes alterations in the expression of thousands of genes in different patterns and the organization of these genes into networks, complete with nodes where perturbation has the maximum effect. It is true that results from the latest research in genomics, proteomics, metabolomics, and various other -omics have led us to think of many diseases in more of a systemic fashion. It is not, however, true that any of these advances validates the woo that is functional medicine. Yet, that is what Hyman tries to argue.

First, of course, he has to expand a bit on the same old tired alt-med tropes about how his woo treats the “real cause” of disease while “conventional medicine” only treats the superficial aspects of disease; i.e., the symptoms. Hyman likens modern medicine as being like trying to diagnose a malfunction in a car by listening to the noises it makes without ever looking inside to see what’s going on. He even has the supreme arrogance to claim that, in contrast, functional medicine allows us to “take a look under the hood” to see what’s gone wrong. Well, it might not be arrogance if he actually had the goods, but, as I’ve described before, functional medicine is chock full of woo. Wally Sampson once catalogued the different aspects of functional medicine as described by Dr. Hyman himself, including an obsessive focus on “detoxification,” along with misguided advice on environment and diet that include advice such as “sugar is poison” and that autistic children have “swollen brains” such that, if the swelling is treated, autism “goes away.” Of all these, though, the obsessive focus on detoxification is the most persistent woo that, as far as I can tell, defines functional medicine. Of course, Dr. Hyman can’t define these “toxins” or prove that they cause the diseases he claims, but he thinks they need to be removed just the same.

He also thinks that the latest cancer research somehow validates functional medicine:

Classifying tumors by body site–lung, liver, brain, breast, colon, etc.–misses the underlying causes, mechanisms and pathways involved in a particular cancer. The fact that cancer appears in a given region of the body tells us nothing about why the cancer developed in the first place. What’s more it gives us no information about how it manifested in a given patient. Two people with cancers in different parts of the body may have developed it for same reasons. Similarly, two people with cancers in the same part of the body may have developed it for different reasons. A patient with prostate cancer and one with colon cancer may have more in common with each other than two patients who have colon cancer. Historically we have practiced medicine by geography–where a disease occurs in the body. That doesn’t make scientific sense anymore. Now we have the potential to treat illness by understanding the underlying mechanisms and metabolic pathways.

Whoooaaaa! Now hold on there, pardner! Dr. Hyman seems to be getting way ahead of where the data is. It’s absolutely not true that it doesn’t make sense anymore to classify tumors by tissue of origin. Yes, it’s true that different cancers originating from the same organ can have very different biological properties. I’ve even pointed this out myself on many occasions in the context of describing the biological variability of cancer. It’s even true that genomic profiling of cancers is providing insights to biology that our old methods of histology and looking at the expression of individual genes, either by immunohistochemistry or other methods. In breast cancer, for instance, based on whole genome expression profiling (i.e., cDNA microarrays or “gene chips”), scientists identified subtypes of breast cancer that we hadn’t suspected before. But you know what? It was all still breast cancer. It was still all identifiable as being of mammary origin. It was not a description of radically different diseases, but rather different “flavors” of a recognizably distinct disease. Yes, there is a lot of biological variability. That biological variability, however, is not so enormous that it no longer makes sense not to categorize cancers by their organs of origin. Such information is still enormously useful clinically.

You know, what really amuses the heck out of me is how Hyman seems to think that the concept of cancer as a systemic disease is something new, something radical, something that no one had thought of before until it sprung up from the recent advances in genomic medicine and systems biology. It’s such a load of laughably fetid dingo’s kidneys to anyone who knows even a little bit about the history of cancer therapy. Let’s just take breast cancer. Bernie Fisher, for example, first proposed the concept of breast cancer as a systemic disease over 30 years ago. His advocacy of breast cancer as a systemic disease was a major paradigm shift that contributed to the decline of the radical mastectomy in favor of less invasive surgery plus adjuvant chemotherapy. To point out a more recent example, over the last decade, the concept of cancer stem cells, which are highly resistant to therapy and can rapidly regrow after therapy, has similarly contributed to the concept of cancer as a systemic disease.

Of course, those nasty, reductionistic, “Western” oncologists just don’t understand:

The problem with cancer–one which almost no oncologists think about–is not the tumor, but the garden in which the tumor grows. In caring for a garden, if the weeds get too big, we pull them out, just as we do with cancer using conventional therapies such as chemotherapy, surgery or radiation. But then what?

[…]

We have been asking the wrong question about cancer. We have asked “what”: What tumor do you have? What kind of chemotherapy, surgery or radiation is needed for that tumor? What is your prognosis? Instead, we need to be asking “why” and “how”: Why did this cancer grow? How can you change the conditions that feed and support cancer-cell growth? How did the terrain of your garden become a host to such an invasive weed?

Nonsense. Utter nonsense. The question of why cancer develops and grows has been central to cancer research since the 1970s at least, if not longer. The concept of cancer as a systemic disease is nothing new. The difference is that for the first time we have the tools to test this idea and characterize what it means. We finally have the technology to measure the expression level of every gene in the genome simultaneously and the computational power to detect patterns in the data and, more importantly, study how those patterns change in cancer and during therapy. Moreover, we have been studying how tumors begin, how they develop, and looking for ways either to prevent them from progressing to full-fledged cancer. Has Dr. Hyman ever heard of the Vogelstein sequence in the development of colorectal cancer from normal epithelium? Has he ever heard of ductal carcinoma in situ (DCIS)? (Of late, I’ve become interested in how DCIS develops into cancer.) Has he ever heard of the tumor microenvironment (i.e., the “soil” in which cancer grows? I wonder. I really do. One of the commenters suggested that Mark Hyman should go to the AACR meeting, that he might learn something there. I doubt it. More likely, Hyman would misinterpret what he sees there, too. After all, he manages to misinterpret genomic medicine and systems biology to support his “functional medicine” woo:

Surprisingly, scientific literature is abundant with evidence that diet, exercise, thoughts, feelings and environmental toxins all influence the initiation, growth and progression of cancer. If a nutrient-poor diet full of sugar, lack of exercise, chronic stress, persistent pollutants and heavy metals can cause cancer, could it be that a nutrient-dense, plant-based diet, physical activity, changing thoughts and reactions to stress, and detoxification might treat the garden in which cancer grows? Treat the soil, not the plant. It is a foundational principle of sustainable agriculture, and of sustainable health.

Don’t you just love analogies where we’re likened to agriculture? Unfortunately, analogies seem to be all that Hyman has. He also likes to play the “we don’t know yet” gambit to make it sound as though his woo is true. For instance, he points to the President’s Cancer Panel report, making a bit too much of its conclusions. Of course, the President’s Cancer Panel did a reasonably good job of pointing out the potential risk between environmental toxins and cancer, but it also struck me in retrospect as making some claims that weren’t well supported by science. Be that as it may, even if the President’s Cancer Panel report were as close to perfect as a scientific report could be, that wouldn’t mean that a “a nutrient-poor diet full of sugar, lack of exercise, chronic stress, persistent pollutants and heavy metals can cause cancer” or support a “yes” answer to the question, “Could it be that a nutrient-dense, plant-based diet, physical activity, changing thoughts and reactions to stress, and detoxification might treat the garden in which cancer grows?”

Truly, Hyman’s ability to leap tall buildings at a single bound to unjustified conclusions is beyond compare.

He can’t even make sense about easily verifiable bits of information:

Consider this fact: The lifetime risk of breast cancer of those with the “breast cancer gene” or BRCA1 or 2 is presently 82 percent and increasing every year. Before 1940, the risk of getting cancer for those with the cancer gene was 24 percent. What changed? Our diet, lifestyle, and environment–both physically and emotionally. Might these factors be a better place to look for answers on how to address our cancer epidemic?

When I read this paragraph, my reaction was: WTF? The BRCA1 and BRCA2 breast cancer susceptibility genes weren’t even discovered until 1994 and 1995. A little Google-Fu revealed this New York Times story, which led me to this study. Always go to the original study, I say, which is not what Dr. Hyman appears to have done. Specifically, the study showed that the lifetime risk of breast cancer in women born before 1940 was still around 80%. What Hyman is referring to was the risk of breast cancer by age 50. In other words, in women born before 1940, the lifetime risk of breast cancer was almost as high as it was for women born later. The real difference was that women born before 1940 developed their breast cancer at a later age, and it turned out that several factors were associated with this later age at onset. These included pregnancies, physical activity, and lack of obesity during adolescence.

From my perspective, this study, while intriguing in that it tells us that, even in the presence of BRCA1 and BRCA2 mutations, the risk of breast cancer is potentially modifiable. What modifies the risk, however, are factors that we’ve known for a long time, namely pregnancy, obesity, and exercise, the last of which is obviously not independent of obesity, given that a lack of exercise can lead to obesity. In any case, there’s nothing radical about this study. It shows that the lifetime risk of breast cancer for women carrying BRCA mutations is still on the order of 80%, but that already known factors that affect breast cancer risk can delay the onset of these nigh inevitable cancers so that they don’t appear until a later age. It suggests nothing about “emotional” environment. It might suggest something about changing diet and exercise, but not really anything we don’t already know. As usual, Hyman is taking legitimate research and stretching it way too far:

We can also alter how our genes are expressed by changing the inputs that control that expression: diet, nutrients, phytonutrients, toxins, stress and other sources of inflammation. And we can focus on less divisive and more generative thoughts that, in turn, create more uplifting emotions–all good fertilizer for the soil in the garden of our body.

Yeah, just keep thinking those good thoughts, and everything will be OK. Get rid of those evil humors toxins. Take all those supplements (many, no doubt, sold by Hyman himself), and you’ll never have cancer! Or, if you do, it’s your fault but you can still cure yourself if only you listen to him!

I find it profoundly depressing that physicians like Mark Hyman are so capable of being so easily seduced by woo. He’s bought into a whole package of dubious alt-med, repackaged it as “functional medicine,” and sold it as being really and truly scientific. Worse, he’s even managed to sell it in the halls of power, representing functional medicine to alt-med-friendly legislators like Senator Tom Harkin as somehow being the “future” of medicine, real preventative medicine that will actually decrease health care expenditures. Too bad it’s the same old woo in a fancy new science-y package.

More money for way less effort. That may be what motivates the woo love here.

That and the natural shrinking of patients from facing the need to have surgery/chemo/radiation. Hyman (and other charlatans) represents an out, an easier path. In the face of any uncertainty many people will grab at any woo offered, especially if couched in sciency sounding words.

The basic line of thought there seems to be, roughly, “tobacco smoke causes lung cancer, so if you stop smoking your cancer will go away.” Or maybe “you got a concussion in a car accident, so stop riding in cars and you’ll heal better.”

If I may go off on a tangent: yes, obesity correlates with lack of exercise, but has there been much study of how these two factors separately affect cancer? I’m thinking of either studies comparing relatively thin people who exercise with those who don’t, and similarly for fat people. I gather that with breast cancer, at least some of the risk is because of body fat and estrogen, but does that generalize to other cancers?

I’m thinking of blood pressure, where the key seems to be blood pressure, and exercise can help control that at any body weight. And lack of exercise can be problematic there even for thin people: one of the problems of so many stories emphasizing the correlation between exercise and weight is that thin people may assume they don’t need to exercise. (It’s not as though there aren’t lots of people who want an excuse not to exercise.)

It appears that Hyman is marketting to 2 groups on his website : women** and physicians- his website has a section devoted to his “Online Formulary” for health care practitioners where he sets them up in a “turn-key” operation selling supplements, etc. MLM style, *and* he is also available as a “presenter” at conferences ( but whose, pray tell?).

** What is it with woo-meisters and women anyway? Hyman worked at the Canyon Ranch Spa sharpening his woo-sensitivity skills, as did Oz and Chopra on Oprah. Doesn’t web woo pseudo-science , including anti-vax momism, often target women as easier marks, perhaps derived from that tired, old adage that women can’t *possibly* understand math and science, or even logic (Hah!)? Witness Perricone and his skin care line, so-called “Anti-Aging” Medicine, various diets and de-tox formulas aimed at women’s weight concerns. If you peruse web woo, you’ll see what I mean ( although I’m definitely *not* saying that there isn’t also “Herbal Viagra” and “Super Muscle Builder” nonsense as well).

I’m thinking of either studies comparing relatively thin people who exercise with those who don’t, and similarly for fat people.

Sounds quite difficult to do properly to me. Exercise has sufficient impact on weight that one has to suspect that thin people who don’t exercise are systematically different than thin people who do, and so on.

( Please forgive me if this doubles, my comment appears to have gotten lost )

Hyman appears to be marketting to 2 groups : women** and physicians. Via his website’s “online formulary”, he sets up health care practitioners in a “turn key” operation selling supplements MLM-style, *and* he is available as a “presenter” at conferences ( but whose, pray tell?)

** Really, what is it with woo-meisters and women anyway? Hyman worked at the Canyon Ranch Spa, perfecting his woo-ful sensitivity skills, as did Oz and Chopra on Oprah. Perhaps they subscibe to the tired, old ( delusional) adage that women can’t *possibly* understand science, math, or even logic. Web woo, including anti-vax Momism, seems to focus on women’s (percieved) needs , e.g. Perricone and his skin care line / diet, so-called “Anti-Aging” medicine, and the myriad diets, de-toxes, and exercise programs aimed at women’s weight concerns, Mama Bear needs,etc.. If you peruse web woo, you’ll see what I mean, however, I’m explicity *not* saying that there isn’t also nonsense aimed at men ( “Herbal Viagra”, “Super Muscle Builders”, faux “Steroids)

No matter what kind of pseudoscience I come across, (and I am including pseudo political science to get the likes of Glenn Beck in there) there seems to be two major things in common with their proponents
1) Their world view is the solution to issue in the field. (IE the solution to any political problem is just that we were not quite right wing enough)

2) There is just no chance they are wrong, but to further that point, any piece of evidence they come across at all is always proof that they are right, no matter what that evidence actually shows.

Donna: that and to, to the extent possible, to find out whether obesity is in itself a risk factor, or simply correlated to a risk factor. It’s like asking whether African-Americans as a group are at higher risk of something, or whether that’s a consequence of the high poverty rate in that group. And don’t assume you know the answer for one disease because you know it for another: Sickle-cell anemia is genetic and that gene correlates with recent African ancestry; asthma is in part a disease of poverty because of exposure to air pollution.

It would definitely be worth looking for other ways in which thin people who don’t exercise (and they do exist) are different from thin people who do. And for ways in which fat people who do exercise are different from fat people who don’t.

It should be possible to define groups that way (or sedentary, light exercise, heavy exercise) and see what the cancer incidences are. I suspect that some large, ongoing study like the Framingham Nurses Study has measured weight, asked about exercise levels, and tracked cancer rates.

The common assumption is that there is no difference in health between fat, active people and fat, sedentary people. It sounds as though at least some cancer researchers are acting on that assumption, and assuming that you can predict cancer rates using either variable without the other. But that assumption is based on the idea that weight and exercise are so strongly correlated that the sets {thin, sedentary people} and {fat people who exercise} should both be very small if not empty. Checking that idea would be worth doing. And even if the number of thin, sedentary people is low (relative to all thin people or all sedentary people) it’s worth asking whether their cancer risk (or other health risks) are those of other thin people, or of other sedentary people. Ditto for fat, active people.

Vicki, the World Cancer Research Fund compiles information on Food, Nutrition, Physical Activity and cancer risk. Their findings are published in an Expert Report that sums up what is known about the preventive/causative effects of various foods, types of activity, alcohol, etc. Would Orac recommend this as a good source? It’s evidence-based and not woo-ey at all.

superdave, the problem with economics, political science, etc. is that it’s difficult to do experiments. If I argue that the unemployment rate would have been higher without Obama’s stimulus, and you argue that the unemployment rate would have been lower, how can we solve our dispute? We can’t rewind time and prevent the stimulus bill from passing. That’s why I’m VERY reluctant to apply the term pseudoscience to odd theories in economics, political science,etc.

Maybe (highly likely, in fact) I’m just being dense… but all I can think of is “duh – wouldn’t that be the point of the research?”

My point is that there would be substantial confounders. For instance, it’s likely that thin people who don’t exercise would on average eat fewer calories than thin people who do exercise. So you’d be getting dietary effects in there. Correct for diet, and base metabolic rates are probably pretty different.

Picking out what’s due to the difference in exercise vs. the other factors that must be different to produce the same weight for different amounts of exercise, would be very hard indeed.

Not to discourage anyone, but most studies I’ve seen looking at dietary interventions in cancer have been flops. Most studies of fruit and vegetable consumption have come out with relative risks in the 1-1.5 range. Not a very impressive effect. Especially since some have indicated an increased risk of certain cancers with increased consumption of certain fruits or vegetables (ie. glioma and citrus fruit:http://www.ncbi.nlm.nih.gov/pubmed/19216998)Anyway, a brief run through medline didn’t reveal any associations worth worrying about. Certainly not of the level of risk that smoking represents. It’s really all kind of underwhelming.

The question is, why would diet/number of calories be a confounder with regard to exercise and not with regard to obesity? Not all fat people eat the same amount (even adjusted for height and/or body weight). And the difference does matter: if number of calories/day is the relevant factor, someone who cuts calories without losing weight would be affecting their risk. If calories/day is irrelevant, they wouldn’t.

From another angle, suppose a low metabolic rate is a risk factor for cancer. Wouldn’t it make sense to focus on metabolic rate, rather than body weight?

“We can also alter how our genes are expressed by changing the inputs that control that expression: diet, nutrients, phytonutrients, toxins, stress and other sources of inflammation. And we can focus on less divisive and more generative thoughts that, in turn, create more uplifting emotions…”

For starters, it is a trivial statement that we can “alter how our genes are expressed” through diet (including “toxins”) – stop eating lactose and the expression of genes for lactase decreases. Eat more phytotoxins (why don’t the woo-minded ever think about these?) and the expression of genes for certain liver enzymes increases. Simple and not very insightful.

However, the part about “…less divisive and more generative thoughts that, in turn, create more uplifting emotions…” seems to be lacking in scientific support. Can I turn on (or off) genes by thinking “good” or “happy” thoughts? There’s no data supporting that hypothesis.

It’s not that I wouldn’t like it to be true, just that wanting something to be true (even if I really, really want it) doesn’t make it true. But just think what we could do if our thoughts could control our genes. I could switch off the telomerase in any incipient cancers that are developing. I could switch on certain genes and regenerate stem cell populations… On the other hand, maybe it’s better if I don’t muck around with my gene expression.

I’ll give Dr. Hyman this – it sounds like science. Unfortunately, it’s really just jabberwocky. He might as well be saying that the square root of red is turqoise or that gene expression is affected by quantum entanglement with our parents’ genes and that’s why we ended up with mother’s eyes or father’s nose (I think Deepak Chopra may have already said that).

Prometheus – the happy thoughts requirement is so that when the other stuff fails, “you just didn’t think happy hard enough” will be a handy excuse.

Scott – I have never thought that scientists were just looking for easy questions to answer or for easy answers. (Most of them anyway – there are some studies that have made me wonder about that.) And I think it’s true that the more we learn about cancer or obesity, the more complex the questions will be.

Does anyone know whether the woo-peddlers have jumped on the research suggesting certain cancers like leukemia MAY be caused by infection? Like… toxins? Or should I just keep quiet and hope they don’t latch on to this research before credible scientists have taken it further?

I get really, really frustrated when these bozos assume cancer treatment is ignoring the cause of the cancer. When cancer has manifested, you kind of don’t have a choice but to treat the “symptoms,” as quickly as you can to prevent the cancer spreading. Doesn’t mean you can’t look for the cause while you are treating the symptoms.

@ #6: So he’s against sugar and for plant based foods. Makes me wonder where he gets his sugar from, high-fructose beef extract?

Interest, newsletter, etc.

It’s always fascinating to me that these diet-woo pushers emphasize plants – including lots of soy, which is a phytoestrogen, and which some Americans consume in massive amounts (thanks to it being labeled a “wonder food”, it gets shoved into everything). I lost a great friend (younger than me) to breast cancer, and one of the things she was specifically warned against was soy, since it could trip her estrogen-sensitive cancer into recurrence (roughly – I am not a doctor).

But then, according to Hyman, she must not have thought “positive” enough. Grrr.

I don’t see what’s necessarily so wrong with treating symptoms. If I go to the doctor, as a layman, complaining of symptoms x, y, and z, and they take steps to get rid of symptoms x, y, and z (and hopefully make sure they don’t recur), I’m happy. If I go to an “alternate practitioner” in the same circumstances, and they take steps to “cure” me, claim to have done so, but I still have symptoms x, y, and z, I’m going to be pissed. (I’m aware it’s more complicated than that, but I’ve read stuff about people using alternate crap and getting more sick, or at least staying as sick as they were, and claims that they’re then “cured”- alongside the “conventional medicine only treats symptoms” claim it all seems ludicrous to me)

OT but are concerted efforts to spread the woo *ever* _truely_ OT @ RI ?) As a postscript to Vaccine Awareness Week, AoA has asked supporters (11/9/10; 11/10/10) to sponsor a 30 second Safe Minds PSA** in “major market” movie theatres that warns of the “dangers” of mercury in flu vaccines. They have included prices/ number screens, number of viewings.

But if you took “color” to mean “energy (or wavelength) associated with a certain color of light” couldn’t you actually measure and then take a square root of that? 😛

That said, I suppose one could argue that his viewpoint on “changing gene expressions” isn’t TOO far from some views on epigenetics — from what I understand, mind you; I’m not a biologist — though since he’s not talking about actual inheritance of epigenetic traits (i.e., through offspring) it doesn’t make much sense to me.

But if you took “color” to mean “energy (or wavelength) associated with a certain color of light” couldn’t you actually measure and then take a square root of that?

[needless pedanticism about an obvious joke]
If you take the square root of a wavelength, then the units of the resulting quantity are (length)^0.5. It is no longer a wavelength. Similarly, the square root of a quantity of energy is no longer an energy.

Dimensional analysis and carrying through your units is key! (And oh, how my students hated me when I was a TA – for taking off points when they just put the units in at the end.)
[/needless pendanticism]

He did a video on the “science” of homeopathy, using notably some excerpts from John Benneth.
Mr Benneth retaliated recently by claiming an infringement of copyright and had C0nc0rdance’s video removed from Youtube.